Problem behaviors usually attract attention and the receipt of attention can be rewarding. Thus, such behaviors often result in the resolution of some personal needs that prompted them. Of course, this outcome can reinforce those behaviors and encourage their expression in the future—exactly the opposite of a desirable treatment.

A few examples will clarify this point. A child who has a terrible toothache and cannot produce the words to talk about the pain may begin to strike the mouth area, either as a means of alleviating the pain or as an attempt to indicate its location. While producing this behavior, the child notices that the parents become upset and provide the desired attention. While trying to stop the self-injury, the parents may also discover the mouth infection and provide the appropriate treatment. When the child again wants attention, he or she may try striking that area of the mouth again, even though the initial reason for the behavior no longer pertains.

In another example, an adult with developmental disabilities and limited impulse control is asked to share a room with an individual who screams at night. The situation is highly volatile, and this adult, in an attempt to quiet the screaming, hits the roommate rather than selecting a less aggressive strategy. (This person also may have executive functioning deficits that cause great difficulty in finding alternate ways of quieting the roommate, or may have communication deficits that make it difficult to express dissatisfaction to caregivers. Thus, aggression toward the roommate is the only method this adult can deduce to express dissatisfaction with the living situation.) When the adult is removed from the room to prevent injury to the roommate, the aggression has resolved the problem by terminating exposure to the screaming. Thus, a situation that arose because of deficits in certain skill areas can result in learning that aggression is a very effective way of having one’s needs met.

Adapted from: Sudhalter V. Problem behaviors in individuals with developmental disabilities. In: Devinsky O and Westbrook LE, eds. Epilepsy and Developmental Disabilities. Boston: Butterworth-Heinemann; 2001;165–174.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised May 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.